Organization · Type 2 NPI

Peak Medical Oklahoma No. 12, Inc.

Intellectual Disabilities Intermediate Care Facility · Henryetta, OK

NPI number 1851346142 Active

Practice location

600 Lake Rd
Henryetta, OK 74437-5415

Call (918) 652-8101 Map

Fax (918) 652-8209

Mailing address

101 Sun Ave NE, Compliance Department
Albuquerque, NM 87109-4373

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	NH56055605 (OK)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

Another provider at this address

Lake Drive Health Care LLCIntellectual Disabilities Intermediate Care Facility Henryetta, OK NPI 1598002966

Other intellectual disabilities intermediate care facility providers in Henryetta

See all in Henryetta →

NPI record

NPI: 1851346142
Entity type: Organization (Type 2)
Issued: May 24, 2006
Last updated: Sep 28, 2009
Status: Active
Subpart: Yes of Sunbridge Healthcare Corporation

Other names

<unavail>
Lake Drive Home · doing business as

Authorized official

William A. Mathies
President Director
(505) 821-3355

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1851346142

Peak Medical Oklahoma No. 12, Inc.'s National Provider Identifier is 1851346142, issued on May 24, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Henryetta, OK. The record was last updated on Sep 28, 2009.